Data-driven care manager outreach improves pregnancy outcomes

The Lead Case Manager at the Health Plan of San Joaquin wanted to better manage high-risk pregnancies to keep babies healthy, prevent moms from enduring the unnecessary risk of preventable c-sections, and shorten recovery times. Many HPSJ members lack sufficient postpartum support and access to cars for follow up care, so improved outcomes would meaningfully impact their birth experiences. And keeping moms and babies healthier would also enable HSPJ to redirect its resources to higher need patients.

The Lead Case Manager joined the Advisory Board’s high-risk pregnancy collaborative and worked with other health plans to learn about best practices, develop strategies, work through obstacles, and hold each other accountable for progress. He developed a new algorithm that integrated new data from physician forms and prescriptions, and updated the algorithm more frequently to identify patients to target for care management enrollment. HPSJ hired a nurse to focus on caring for just high-risk moms, and armed her with outreach strategies, scripts and tools for engaging moms.

Within 2 months of starting, the dedicated nurse had a full case load. She identifies over 38% more potential high risk pregnancies per month, finds these moms an average of 2 weeks earlier, and has been successfully enrolling participants in tailored care management programs. She connects with some moms in-person throughout their pregnancies, and she just sends along relevant information at critical junctures to other moms.

The impact: HSPJ is seeing fewer c-sections and fewer premature babies, and moms and newborns are spending more quality time together. Just one way that HPSJ is improving the health of San Joaquin and Stanislaus Counties.

• A full term baby averages 2 days in the hospital, but a premature baby stays an average of 15 days in the hospital.
• A full term baby averages 14 outpatient visits following delivery, but a premature baby averages 20 outpatient visits

Real-world tactics and strategic guidance health plans need to solve their current challenges and make smart investments for the future.